hormones
What Does a Low AMH Result Mean?
A low AMH level is usually related to natural aging, but it can also have other causes. In this article, we’ll explore what a low AMH result means and answer some common questions that can come up.
Anti-Mullerian hormone (AMH) is a hormone produced by the follicles in the ovaries (the fluid filled sacs that contain eggs). It requires a simple blood draw and is most often used as a marker of ovarian reserve. Ovarian reserve is the term for the number of healthy eggs left in your ovaries. Since people with ovaries are born with a fixed number of eggs, this number naturally declines over time.
A low AMH level is usually related to natural aging, but it can also have other causes. In this article, we’ll explore what a low AMH result means and answer some common questions that can come up.
AMH and its role in fertility
So what exactly can AMH tell you about your fertility? As mentioned, your AMH level is positively correlated with the number of follicles you have in your ovaries. Simply put, the more follicles you have, the higher your AMH level typically is. As a result, AMH levels have been shown to be a good predictor of ovarian reserve and someone’s expected response to fertility treatments.
In fact, several studies have shown that there is a strong correlation between what your AMH level is and the number of mature eggs retrieved during an egg freezing or in vitro fertilization (IVF) cycle. To learn more about those studies, check out AMH and Egg Retrieval Outcomes.
What your AMH level can’t tell you is the exact number of eggs you have left in your ovaries or what your chances of pregnancy are. There are a number of other factors like your age, overall health, and genetics that also affect the number and quality of eggs and your overall fertility. So while AMH can be a useful tool in assessing your fertility, it shouldn’t be the only factor when making decisions about fertility treatments.
What is a low AMH result?
As with most things in medicine, there’s no absolute answer here. What is considered a low, normal, or high AMH level depends on your age and the lab where you take the test. Since there is no international standard, it’s best to use the reference ranges that come with your test results.
In general, an AMH between 1.0 and 3.5 ng/mL is considered to be in the “normal” range, which means you’re likely to have a good response to fertility treatments. Anything below 1.0 ng/mL is considered low and a sign of a declining ovarian reserve.
What does a low AMH mean?
Having a low AMH level can be a sign that your ovaries are making less of the preantral follicles. The lower the number of follicles, the lower your ovarian reserve is.
So what does this mean in terms of fertility?
First, having a lower AMH does not automatically mean you aren’t ovulating regularly or that you won’t be able to get pregnant naturally or with assisted reproductive technologies. However, research has found that what AMH is good at predicting is the response to ovarian stimulation and the number of eggs retrieved, regardless of a person’s age. So, someone with a higher AMH is generally expected to be able to get more eggs in one cycle than someone with a lower AMH. Because of this, fertility doctors typically use AMH levels (along with other information) to figure out the drugs and dosages you’ll need to maximize your response to ovarian stimulation medications.
If you’re trying to conceive naturally, you’ll be glad to hear that multiple studies have shown that AMH does not correlate with how likely you are to actually get pregnant. In fact, one study looked at levels of AMH, FSH, and another ovarian hormone, inhibin B and tracked people for a year. They found that there was no correlation between someone’s ovarian reserve and their ability to conceive and that a low ovarian reserve was not associated with lower fertility. As a result, they did not recommend the use of FSH or AMH levels to “assess natural fertility.”
Reasons AMH would be low
There are a few reasons that could explain a low AMH. Let’s explore them.
Natural decline with aging
By far, the most common reason for a low AMH is age. People with ovaries are born with all the eggs that they’re going to have in their lifetime. These eggs are then slowly used up over time as you ovulate during each menstrual cycle until menopause is reached. As a result, ovarian reserve naturally decreases over time, meaning the AMH level also decreases.
Hormonal birth control
Research suggests that hormonal birth control may affect AMH levels but it depends on the type of birth control. Specifically, birth control use is associated with a lower average AMH level than for people who are not on birth control, with the exact effect depending on the type of birth control.
The amount of time you’re on birth control may also be a factor. Multiple studies have shown that AMH doesn't change if you use combined oral contraceptive pills for less than six months. However, you may have a lower AMH if you’ve been a long-term user of the pill (or other hormonal methods). Thankfully, this is temporary – AMH levels typically rebound after a person stops using birth control.
You can learn more about birth control and AMH here.
Tobacco use
Studies have shown that tobacco use, usually cigarette smoking, decreases AMH levels. This effect appears to be reversible though–it was only seen in people who were active smokers, not people who had previously smoked.
Less common causes
There are several other, less common causes for a low AMH level. These include:
- Genetic disorders that affect the X chromosome.
- Medical treatments like radiation or chemotherapy.
- Having surgery on your ovaries.
- Losing one or both of your ovaries.
- Autoimmune conditions.
Can I still donate my eggs with a low AMH?
If you are looking to donate your eggs, minimum AMH requirements are usually 2.0 or above. With Cofertility’s Split program, we require a minimum AMH of 2.0, though clinics may have their own unique requirements. This is to increase the chances of retrieving enough eggs to actually split, to ensure positive outcomes for both parties involved.
What to do if you have a low AMH result
Finding out you have a low AMH can be disheartening, especially if you had future fertility plans that you’re worried may be affected. While there’s unfortunately not much that can be done to reverse a low AMH, there is still hope for starting a family someday even with a low AMH. With the exception of birth control or cigarette smoking, most studies have shown that lifestyle changes like diet or supplements have an insignificant effect on AMH levels but despite this, I promise it’s not all gloom and doom.
Let’s go through a few things you can do as you move forward with this new information.
Lean on your village
The first thing to do is take a deeeeeep breath… There are a lot of nuances involved here which can make it hard not to get lost in the weeds. Fertility is impacted by so many different things that you can drive yourself crazy trying to manage all of them.
Having friends, family, and mental health specialists available to support you when you need it is going to be crucial. Navigating fertility is hard no matter what, so having people around you who you can lean on on bad days and celebrate with on good days will help immensely.
Consult a fertility specialist
Speaking of your village, it should definitely include a fertility specialist. Consulting with a fertility doctor can help you better understand your reproductive health and provide guidance on any concerns or questions you may have. They’ll be able to review your specific options and work with you on a plan that helps you reach your family-building goals. This treatment plan will depend on a lot of things including how soon you want to have a child, how many children you want to have, your finances, and your desire to have a child who is genetically related to you.
So does this mean I have to freeze my eggs ASAP?
This is typically the first question people ask and the answer is not necessarily. As mentioned before, there are many other factors involved in assessing your fertility and modern technology has allowed for advances that make family building a possibility for virtually everyone. Your fertility specialist will be able to discuss all the options for starting a family based on your unique family-building goals. This could certainly include freezing your eggs for later use but it could also mean trying to conceive unassisted, undergoing IVF with your own eggs or with donor eggs, using a gestational carrier, or even options beyond these. Again, this is something that will require you to examine your personal goals and work with your provider to figure out the best way to reach them.
You are not a number
Repeat after me: you are more than one number! Your AMH level provides valuable insights into your ovarian reserve, but it’s just one piece of the puzzle when it comes to your fertility. AMH is always used as part of a full fertility evaluation, which often includes information about your medical history and age, a partner semen analysis, an ultrasound of the pelvis, an x-ray of the uterus and fallopian tubes, and/or additional lab work.
If that sounds like a lot, it is. This process can be overwhelming but focusing on the things that you can control can help you feel more grounded during your fertility journey, whatever that may look like.
How Cofertility can help
Cofertility is here to help you every step of the way on that journey. Our Split program offers women a chance to freeze their eggs for free when donating half the eggs retrieved to a family who cannot conceive otherwise. If you qualify for the program and decide to donate half of your retrieved eggs, every expense associated with the egg freezing procedure — medications, supplements, travel if necessary, insurance, and 10 years of storage — are completely free of charge. We don’t even need a payment or credit card up front, as the family you match with covers all the expenses.
In our Keep program, you can freeze and store your eggs for your own future use, with lower prices on things like storage and medication. as well as our team’s support and access to our community.In addition, you’ll have access to our team’s support and access to our community where you can engage with other people freezing their eggs at the same time!
Your journey is uniquely yours and our team is here to help you through it in whatever way you need.
What is Ovarian Reserve?
If you are considering starting a family or have concerns about your fertility, understanding the concept of ovarian reserve is essential. Ovarian reserve refers to the quantity of eggs (oocytes) available for fertilization. It serves as a key indicator of your reproductive potential and can play a crucial role in fertility treatment decisions.
If you are considering starting a family or have concerns about your fertility, understanding the concept of ovarian reserve is essential. Ovarian reserve refers to the quantity of eggs (oocytes) available for fertilization. It serves as a key indicator of your reproductive potential and can play a crucial role in fertility treatment decisions.
In this guide, we will delve into the topic of ovarian reserve, exploring its significance, how it is assessed, factors that affect it, available options for optimizing fertility, and emotional considerations related to fertility journey.
First off, what does your ovarian reserve mean?
Simply put, your ovarian reserve is your fertility potential, which is influenced by a variety of factors, including age, genetics, and certain medical conditions.
As we age, our fertility naturally declines. This is totally normal, and due to fewer eggs in the ovaries, a decrease in egg quality, and an increase in chromosomal abnormalities of the remaining eggs. These collective factors contribute to lower pregnancy rates and higher miscarriage rates as we approach age 40.
While the decline in fertility happens to ALL of us, the specific age when we can no longer conceive varies from individual to individual. And in some cases, it may be earlier than we expected.
To assess your fertility potential, including your ovarian reserve, several tests are available that can give us clues to our reproductive capabilities. These tests can also help fertility doctors, like myself, evaluate the likelihood of successful pregnancy, and guide you in making informed decisions regarding family planning and fertility treatments.
How do I know my ovarian reserve?
If you want to know your ovarian reserve, it’s best to set up time for a fertility assessment with a fertility doctor (reach out – we can help with this!).
There are two ways a doctor can help assess your ovarian reserve, including:
Blood hormone tests
Hormone tests, including follicle-stimulating hormone (FSH), estradiol, luteinizing hormone (LH), anti-Müllerian hormone (AMH), and estradiol, provide valuable information about ovarian function and egg supply. While AMH can be taken any time, FSH and LH are typically performed on specific days of the menstrual cycle to obtain accurate results.
Antral follicle count
Transvaginal ultrasound is used to visualize the ovaries and count the number of antral follicles present. Antral follicles are small, fluid-filled sacs that contain immature eggs. The count of antral follicles serves as an indirect indicator of ovarian reserve.
By combining the results of hormone tests and ultrasound assessments, we can estimate your ovarian reserve and provide insights into fertility potential.
What is a normal ovarian reserve?
Determining what constitutes a “normal” ovarian reserve involves comparing your results to established reference ranges for your age. Age-specific reference ranges serve as benchmarks to evaluate your ovarian reserve relative to peers of the same age group. Keep in mind that ovarian reserve will gradually decline for everyone – it’s the timing and pace of change that differs.
For example, in younger women, a higher number of antral follicles (small fluid-filled sacs containing immature eggs) and lower levels of certain hormones like FSH may be considered within the normal range. However, as a woman ages, it is expected that the number of antral follicles will decrease and hormone levels, such as FSH, may increase.
While age is a significant factor, other individual factors should also be taken into account when interpreting ovarian reserve results. Factors such as medical history, previous fertility experiences, underlying medical conditions, and fertility goals play a role in assessing the overall fertility potential. These additional factors can influence the interpretation of ovarian reserve results and help guide fertility treatment decisions tailored to the specific needs of the individual.
What causes decreased ovarian reserve?
Decreased ovarian reserve can result from various factors, including:
- Age: As we age, the quantity and quality of eggs naturally decline. The aging process gradually reduces the quality of eggs and ovarian reserve, making it more challenging to conceive.
- Smoking: Cigarette smoking has been linked to a higher rate of diminished ovarian reserve. Chemicals in tobacco smoke can accelerate the depletion of eggs and negatively impact ovarian function.
- Cancer treatment: Some cancer treatments, such as chemotherapy and radiation therapy, can have damaging effects on the ovaries. These treatments may cause a decrease in ovarian reserve and compromise fertility.
- Pelvic Surgery: Surgical procedures involving the ovaries or other pelvic organs can inadvertently damage or remove ovarian tissue. This can lead to a decrease in ovarian reserve and potentially affect fertility.
- Autoimmune diseases: Certain autoimmune conditions, such as systemic lupus erythematosus (SLE) and rheumatoid arthritis, can impact ovarian function and diminish ovarian reserve.
- Genetic conditions: Certain genetic disorders, such Fragile X syndrome, and other chromosomal abnormalities, can be associated with decreased ovarian reserve. These conditions may affect the development and function of the ovaries.
While these factors are known to contribute to diminished ovarian reserve, individual experiences vary. You may have none of the above conditions, and still face premature ovarian failure (POF). Or you may have one of the above factors, and have no problems at all getting pregnant. Sometimes, it just comes down to luck.
What does it mean if I have a high ovarian reserve?
A high ovarian reserve refers to a situation where there is an abundant number of eggs in the ovaries. While ovarian reserve naturally declines with age, certain factors can contribute to a higher ovarian reserve in some people.
One factor associated with a high ovarian reserve is younger age. Those in their 20s and early 30s generally have a higher number of eggs compared to those in their 40s, resulting in a larger ovarian reserve. Additionally, genetic factors can influence ovarian reserve, and some may have a naturally higher number of follicles and eggs in their ovaries.
Another factor that can contribute to a higher ovarian reserve is polycystic ovary syndrome (PCOS). PCOS is a hormonal disorder that can lead to the development of multiple small follicles on the ovaries. Those diagnosed with PCOS often have a higher number of immature follicles in their ovaries, which can translate into a higher ovarian reserve.
While a high ovarian reserve can be advantageous for fertility, it does not guarantee successful conception or a higher chance of pregnancy. Other factors, such as egg quality and hormonal balance, also play significant roles in achieving pregnancy.
At-home ovarian reserve tests
There are at-home options for ovarian reserve testing. However, keep in mind that most fertility doctors will want to re-do these tests. So taking a test at home, may mean paying for a test twice.
Here are some options:
- Natalist Women’s Fertility Test ($149) measures 5 hormones: estradiol, LH, FSH, TSH, and total testosterone
- LetsGetChecked Ovarian Reserve Test ($139) measures 1 hormone, AMH
- Modern Fertility Hormone Test ($179) measures 7 hormones: AMH, TSH, FSH, estradiol, prolactin, fT4, and LH
Ovarian reserve and egg freezing
Ovarian reserve plays a significant role in the process of egg freezing, also known as oocyte cryopreservation. Egg freezing involves the retrieval and freezing of your eggs for future use, preserving your fertility potential at a younger age.
Assessing ovarian reserve before undergoing egg freezing is crucial for determining the quantity of eggs available for freezing. Those with a higher ovarian reserve generally have a greater number of eggs suitable for freezing, increasing their chances of successful future pregnancy.
On the other hand, those with diminished ovarian reserve may have fewer eggs available for freezing, necessitating careful consideration of the potential outcomes and options. Understanding your ovarian reserve provides valuable information to help guide the egg freezing process and optimize the chances of achieving successful future pregnancies when the frozen eggs are thawed and used in assisted reproductive techniques.
Freeze your eggs with Cofertility
We’d love the opportunity to support you on your egg freezing journey.
Cofertility is a human-first, tech-enabled fertility ecosystem that provides people agency over if, how, and when they have babies — today or someday. We have two programs for egg freezers:
- The Split program, which offers women a chance to both freeze their own eggs and donate half the eggs to a family who cannot conceive otherwise. If you qualify for the program and decide to donate half of your retrieved eggs, every expense associated with the egg freezing procedure — medications, supplements, travel if necessary, insurance, and 10 years of storage — are completely free of charge. We don’t even need a payment or credit card up front, as the family you match with covers all the expenses.
- Our self-pay Keep program allows women to freeze their eggs and keep them all for their future use. Through Keep, we offer our members partnerships and discounts to lighten the financial load of egg freezing, as well as access to our member community.
The benefits for of working with Cofertility include:
- Power of choice: Freeze your eggs more affordably or, if you qualify, freeze for free when you give half to a family who can’t otherwise conceive.
- Community: Our inclusive online spaces allow you to connect with others going through the process in our private online community.
- Compassion: We’ll always treat you with care, and our Split program gives you the opportunity to make someone’s family building dreams a reality.
- Data-driven: We provide you with trustworthy guidance and evidence-based research so you can make informed decisions about your fertility.
- Free egg freezing: Freeze and store your eggs for 10 years, entirely for free if you qualify for our Split program.
Ready to learn about more affordable (even free!) egg freezing with Cofertility? Fill out this quick quiz to learn about our accessible egg freezing options and see if you qualify for our programs — it only takes one minute.
What Does a High AMH Result Mean?
Anti-Mullerian hormone (AMH) is a hormone produced by ovarian follicles. It is commonly used as a marker of ovarian reserve and can be measured in the blood. A high AMH level is often associated with polycystic ovary syndrome (PCOS), but it can also have other causes. In this article, we will explore what a high AMH result means and answer some common questions about AMH testing.
Anti-Mullerian hormone (AMH) is a hormone produced by ovarian follicles. It is commonly used as a marker of ovarian reserve and can be measured in the blood. A high AMH level is often associated with polycystic ovary syndrome (PCOS), but it can also have other causes. In this article, we will explore what a high AMH result means and answer some common questions about AMH testing.
First off, what is AMH?
AMH is a hormone that is produced by the granulosa cells in the ovarian follicles. It plays a role in the growth and maturation of ovarian follicles in females. AMH levels are relatively stable throughout the menstrual cycle and can be measured in the blood.
AMH is commonly used as a marker of ovarian reserve, which is a rough number of eggs that a female has remaining in her ovaries. Since females are born with a fixed number of eggs, this number naturally declines over time.
What are normal AMH numbers?
What is considered a “normal” AMH level depends on your age, as well as the lab where you take the test. Since there is no international standard, it’s best to use the reference ranges included on the test results (your doctor can share those with you if you did a test through a clinic).
In general, however, an AMH between 1.0 and 3.5 ng/mL suggests a “normal” range that is likely to have a good response to egg freezing.
If you are looking to donate your eggs, however, minimum AMH requirements may be slightly higher. For example, with Cofertility’s Split program, we require a minimum AMH of 2.0, though clinics may have their own unique requirements. This is to increase the chances of retrieving enough eggs to actually split, to ensure positive outcomes for both parties involved.
What AMH level is considered high?
In healthy females of reproductive age, higher levels of AMH mean that the ovaries have a larger supply of eggs. This means one would be expected to have better than average outcomes for egg freezing.
Remember, there is no universal standard for AMH, so it can vary depending on the lab where the test is run. Your test results will include if your range is “normal”, “low”, or “high” and the cut-off can differ. For example, Atlanta Fertility considers over 4.5 ng/mL high. Advanced Fertility considers anything over 4.0 ng/ml high. While RMA would consider an AMH over 3.0 ng/ml as “very high”.
With high levels of AMH, you may be at higher risk for ovarian hyperstimulation syndrome (OHSS). This means your doctor may choose a specific protocol and/or do extra monitoring to decrease the risk of complications during egg freezing.
What AMH level is considered too high?
Again, this question depends on the lab. Your test results will come with a reference range, and will indicate if your number is high for your age. If your doctor considers your levels abnormally high and has concerns, they will discuss the results with you.
Common reasons for high AMH
The most common reason for high AMH is that you are very fertile and likely to retrieve more eggs in an egg freezing cycle.
But a high AMH level may also indicate PCOS, which is a hormonal disorder that affects 8–13% of females of reproductive age. Those with PCOS typically have high levels of androgens (male hormones) and may have irregular periods, acne, and excess hair growth. Patients with an average AMH level ≥ 4.45 ng/ml have a 9.35 times higher likelihood of developing PCOS, but not all patients with a high AMH have PCOS.
In rare cases, abnormally high AMH could be a sign of an ovarian tumor. Certain types of ovarian tumors, such as granulosa cell tumors, can produce high levels of AMH.
Does high AMH always mean PCOS?
While an increase in AMH levels has been reported to be associated with PCOS, high AMH alone is not enough to diagnose PCOS.
Not all patients with PCOS have high AMH levels, and not all patients with high AMH levels have PCOS. Diagnosis of PCOS requires a combination of symptoms, hormone levels, and imaging studies, such as ultrasound.
Does high AMH mean good egg quality?
Not necessarily. While a high AMH level is often associated with a larger number of ovarian follicles and eggs, it does not necessarily mean that the eggs are of good quality. Egg quality is determined by factors such as your age, genetics, and environmental factors, and cannot be measured directly by AMH levels.
Am I ovulating if my AMH is high?
AMH levels do not indicate if you’re ovulating or not. Ovulation is the release of a mature egg from the ovary and can be confirmed by monitoring the menstrual cycle and/or performing ultrasound studies.
Will I get a lot of eggs if I have a high AMH?
The success of egg freezing outcomes largely depends on the number and quality of eggs retrieved. Studies have shown that AMH levels can be used as a predictor of egg quantity, and can thus help to predict the potential success of egg freezing. Those with higher AMH levels tend to have better outcomes with egg freezing, as they are likely to have more eggs retrieved and a higher chance of success in future fertility treatments.
But by no means does a high AMH level guarantee a lot of eggs during an egg retrieval procedure for fertility treatments. The number of eggs retrieved during an egg freezing cycle depends on several factors, including your age, ovarian response to stimulation medications, any other underlying medication conditions, and the skill of the doctor performing the procedure.
What is a good AMH level for egg freezing?
Research has found that AMH is a good predictor of the response to ovarian stimulation and the number of eggs retrieved. Because of this, fertility doctors typically use your AMH levels (along with other biomarkers) to determine the drugs and dosages you will need to maximize your response to ovarian stimulation.
Now, what about a correlation between AMH and actual babies born (live birth rate)? Well, while AMH does seem to have some association with live birth rates after IVF, its ability to actually predict a live birth is not that great. This is especially true for younger people. A 2021 study found that AMH is a good predictor of live birth in older (>39 years old), but not younger, people. They found that younger participants (≤38 years old) could get pregnant even with low AMH levels as long as they had frequent egg retrievals.
Freeze your eggs with Cofertility
One option to make egg freezing better is working with Cofertility. Through our Split program, qualified freezers can freeze their eggs for free when donating half of the eggs retrieved to a family who can’t otherwise conceive.
Through our Keep program — where you keep 100% of eggs retrieved for your own future use — we offer exclusive discounts on expenses, such as frozen egg storage. Keep members also still gain free access to our Freeze by Co Community, a safe space for those engaging in the egg freezing process (or gearing up for it) to connect and lean on each other. It also enables access to exclusive guidance, free expertise, and community events.
By making egg freezing easier and more accessible, our programs further strengthen the American Society of Reproductive Medicine (ASRM)’s Committee Opinion that egg freezing can help promote social justice and strengthen gender equality.
Summing it up
A high AMH level is generally a good sign for your ability to successfully freeze your eggs. But for some, it can also be one indicator of PCOS. While a high AMH level is often associated with a larger number of ovarian follicles and eggs, it does not necessarily mean that the eggs are of good quality (egg quality is more dependent on age).
AMH levels are commonly used as a marker of ovarian reserve and can be helpful, in conjunction with other measures, in predicting the number of eggs that can be retrieved during an egg freezing cycle. However, it is important to keep in mind that egg quality is determined by several factors and cannot be measured directly by AMH levels. If you have concerns about your fertility or AMH levels, it is important to speak with a fertility doctor for personalized advice and treatment options.
Read more:
Egg Freezing and Birth Control: An Overview
If you’re exploring egg freezing, you may have a lot of questions, including if you can stay on birth control or not. In this article, we will discuss how birth control works and answer common questions about egg freezing while on various types of birth control.
More and more people are freezing their eggs; in fact, in 2021 we saw a 46% increase in egg freezing cycles in the United States. If you’re exploring egg freezing, you may have a lot of questions, including if you can stay on birth control or not. In this article, we will discuss how birth control works and answer common questions about egg freezing while on various types of birth control.
How birth control works
Birth control methods work in various ways to prevent pregnancy. Hormonal methods, such as the pill, patch, ring, and injection, regulate hormones in the body to prevent ovulation. Without ovulation, there is no egg available for fertilization.
Non-hormonal methods, such as condoms, diaphragms, and intrauterine devices (IUDs), physically prevent sperm from reaching the egg or alter the environment in the uterus to prevent implantation. IUDs can be either hormonal or non-hormonal, depending on the type.
If you are freezing your eggs, do not start or stop your current birth control regimen without talking to your fertility doctor.
Can I freeze my eggs while on the pill?
You will need to stop taking the pill before the actual egg freezing cycle. That’s because hormonal birth control is intended to prevent ovulation, but during freezing you want to do exactly the opposite. Some doctors will have you stop during your egg freezing cycle, and some may have you stop for the month leading up to the retrieval.
The irony is that in preparation for an egg freezing cycle, the birth control pill is commonly prescribed for two to three weeks to sync your cycle and reduce the chance of inducing a cyst from the ovulation follicle. It can also help synchronize the cohort of follicles for a more optimal response. So if you’re not on the pill, you may be prescribed birth control pills with the start of the menstrual cycle in which you plan to undergo the egg freezing cycle.
Can I freeze my eggs while on Depo-Provera?
Depo-Provera (medroxyprogesterone acetate) is an injection that contains a synthetic form of the hormone progesterone. Since this shot can interfere with hormonal medications, you You may have to wait up to three to six months after the last shot until your ovaries are in an optimal state to be stimulated.
While Depo-Provera can affect the timing of ovulation, it does not impact the number or quality of eggs that are retrieved during the egg freezing process.
Can I freeze my eggs with an IUD?
Yes! Unlike other forms of birth control, IUDs do not prevent ovulation and therefore will not get in the way of stimulating egg production during your freezing cycle. If you have an IUD, there’s no need to remove it before your cycle. Although if you’ve been meaning to take it out, ask the doctor if they can do it during your procedure.
Studies show that egg and embryo freezing results are the same for patients with or without IUDs.
Can I freeze my eggs with Nexplanon (birth control implant)?
Nexplanon is a small rod that is inserted under the skin of the upper arm and contains a synthetic form of the hormone progesterone. It can remain in place and does not appear to impact the number or quality of eggs that are retrieved during the egg freezing process.
Can I freeze my eggs with the patch?
Like the pill, the patch contains synthetic hormones that regulate the body's natural hormone levels and prevent ovulation. In order to begin an egg freezing cycle, you will need to remove the patch.
Can I freeze my eggs with NuvaRing?
The NuvaRing is a vaginal hormonal birth control ring. Because it’s using hormones to prevent ovulation, like the pill and the patch, you will need to remove the NuvaRing before your cycle. However, your fertility doctor will give you instructions and there’s no need to remove it until they tell you to.
Why is my doctor prescribing birth control to freeze my eggs?!
While it may seem counterintuitive, many fertility doctors recommend or prescribe birth control at the beginning of the egg freezing process. There are several reasons why:
- To coordinate the timing of stimulation start. Hormonal birth control pills can be used to offset the menstrual cycle to help facilitate the best timing for your cycle with your clinic/lab.
- To reduce the likelihood of ovarian cysts. Birth control pills may help to suppress the growth of ovarian cysts, which can interfere with the egg retrieval process.
So while it may seem counterintuitive, using birth control pills before egg freezing is pretty typical.
Summing it up
Hormonal birth control methods work by regulating hormones in the body to prevent ovulation, while non-hormonal methods physically prevent sperm from reaching the egg or alter the environment in the uterus to prevent implantation. While it is possible to freeze your eggs while on various types of birth control, it depends on which one.
- Definitely okay: condoms, diaphragms
- Generally okay: IUD, birth control implant
- Need to stop: the pill, the patch, NuvaRing
- Potential wait of three-six months: Depo-Provera
Of course, do not start or stop your current birth control regimen without talking to your fertility doctor first.
Freeze your eggs with Cofertility
Cofertility is in the “family” business, striving to make egg freezing and third-party reproduction more human-centered and accessible for all. Our Freeze by Co program allows you to freeze your eggs for free when you give half of the eggs retrieved to a family who can't otherwise conceive.
Can Birth Control Affect Your AMH levels?
One common question that arises is whether birth control, a widely used contraceptive method, can affect AMH levels. In this article, we will explore the relationship between birth control and AMH levels to shed light on this topic and provide valuable insights for those concerned about their fertility.
Understanding reproductive health is crucial, especially when it comes to fertility. Anti-Müllerian hormone (AMH) is one of the key markers used to assess ovarian reserve, which refers to the quantity of eggs. Many factors can impact AMH levels, including age, genetics, and certain medical conditions.
One common question that arises is whether birth control, a widely used contraceptive method, can affect AMH levels. In this article, we will explore the relationship between birth control and AMH levels to shed light on this topic and provide valuable insights for those concerned about their fertility.
What is AMH?
Before delving into the impact of birth control on AMH levels, let's first understand what AMH is and its significance in assessing ovarian reserve. AMH is a protein produced by the small follicles in the ovaries. These follicles contain immature eggs, and the level of AMH in the blood provides an estimate of the remaining egg supply. Ovarian reserve tests can help you make decisions about egg freezing. In general, higher AMH levels indicate a larger number of follicles and potentially better ovarian reserve, while lower levels may suggest a diminished egg supply.
Can birth control affect your AMH levels?
One common concern among women is whether taking birth control can influence AMH levels. Birth control methods, such as oral contraceptive pills (aka “the pill”), patches, injections, and intrauterine devices (IUDs), work by regulating hormones and preventing ovulation. So it is reasonable to question whether these hormonal interventions can impact AMH levels.
Research suggests that hormonal birth control may affect AMH levels. But it depends on the type of birth control.
One study looked at data from women on various types of birth control and found:
- Combined oral contraceptive pill led to 23.7% lower AMH
- Progestin-only pill led to 14.8% lower AMH
- Vaginal ring led to 22.1% lower AMH
- IUD led to 6.7% lower AMH
- Implant led to 23.4% lower AMH
- Copper intrauterine device led to 1.6% lower AMH
The authors concluded that birth control use is associated with a lower mean AMH level than for women who are not on contraceptives, with variation depending on the type of birth control
Learn more: Egg Freezing and Birth Control: An Overview
The amount of time you are on birth control may also be a factor. A systematic review of 15 studies concluded that AMH is unchanged in women using combined oral contraceptive pills if they were using it under six months.
However, they found a lower AMH in long-term users of the pill. But it’s just temporary – AMH levels rebounded after they stopped using birth control.
Is AMH accurate if on birth control pills?
One study compared the AMH levels of 228 hormonal contraception users and 504 non-users. They found that users of birth control had 29.8% lower AMH concentrations. Because of this, the authors concluded that AMH may not be an accurate predictor for women using hormonal contraception.
You may want to consider the timing of the AMH test when using hormonal contraceptives. Estrogen can suppress the production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are necessary for the development and maturation of follicles.
As AMH levels are influenced by FSH and LH, you could wait for a few weeks after discontinuing birth control before measuring AMH levels for a more accurate assessment of ovarian reserve. Or, you could take the test knowing the results may be lower due to birth control. It’s best to discuss this with your doctor.
Do I need to get off birth control to get AMH tested?
In general, it is not necessary to discontinue birth control before getting an AMH test. However, it's important to be aware that hormonal contraceptives, such as oral contraceptive pills, can potentially lower AMH levels temporarily while being used. This means that if you are currently using birth control, the AMH results may be lower than they would be if you were not on contraceptives.
If you are concerned about the accuracy of your AMH test or have specific fertility-related questions, it’s best to consult with a fertility doctor. They can provide personalized guidance based on your individual circumstances and help you understand how birth control may impact your AMH results. They will take into consideration factors such as the type of birth control you are using, your reproductive goals, and any underlying medical conditions. This will help ensure that you receive the most accurate and relevant information regarding AMH testing and its interpretation.
Will my AMH change if I get off birth control?
AMH can and will change throughout your life. And, it is generally believed that AMH levels should return to their baseline after stopping hormonal contraceptives.
Birth control methods, such as oral contraceptive pills, work by suppressing ovulation and altering hormone levels. Once you discontinue birth control, your body will naturally resume its normal hormonal patterns, and AMH levels should stabilize accordingly.
Individual responses to stopping birth control may vary. Some may experience a temporary fluctuation in their hormone levels as their body adjusts, which could potentially affect AMH measurements. However, these fluctuations are typically short-lived, and AMH levels should gradually return to their baseline within a few menstrual cycles.
If you are planning to assess your ovarian reserve through an AMH test, you may want to wait for a few weeks or consult with your fertility doctor to determine the most appropriate timing after discontinuing birth control. This will help ensure a more accurate assessment of your current ovarian reserve without the influence of hormonal contraceptives.
Remember, AMH levels provide valuable insights into ovarian reserve but are just one piece of the puzzle when it comes to fertility.
Does birth control help egg reserve?
Although birth control does not directly affect AMH levels or egg reserve, it can provide some indirect benefits related to reproductive health. By preventing ovulation and regulating menstrual cycles, birth control can help manage various gynecological conditions such as polycystic ovary syndrome (PCOS), endometriosis, and irregular periods. By providing symptom relief and controlling hormone levels, birth control can potentially improve overall reproductive health (thanks birth control!).
Additionally, certain forms of birth control, such as combined oral contraceptive pills, may help reduce the risk of ovarian cysts and decrease the incidence of ovarian and endometrial cancers. These benefits contribute to the overall well-being of your reproductive system, indirectly supporting egg reserve.
AMH and egg sharing
If you are looking to donate your eggs through Cofertility’s Split program, where you freeze for free in exchange for donating half to a family that could not otherwise conceive, we require a minimum AMH of 2.0 (though clinics may have their own unique requirements). This is to increase the chances of retrieving enough eggs to actually split, to ensure positive outcomes for both parties involved.
You are not a number
With all the nuances involved here, it’s important not to get lost in the weeds. Fertility is impacted by so many factors that you can drive yourself crazy trying to manage all of them.
Remember, you are more than any number. This process can be overwhelming, but focusing on the things that you can control can help you feel more grounded during your fertility journey, whatever it may look like.
Cofertility is here to help you every step of the way on that journey.
Our Split program offers women a chance to freeze their eggs for free when donating half the eggs retrieved to a family who cannot conceive otherwise. If you qualify for the program and decide to donate half of your retrieved eggs, every expense associated with the egg freezing procedure — medications, supplements, travel if necessary, insurance, and 10 years of storage — are completely free of charge. We don’t even need a payment or credit card up front, as the family you match with covers all the expenses.
Or, in our Keep program, you can freeze and store your eggs for your own future use, with lower prices on things like storage and medication – as well as our team’s support and access to our community.
The benefits for of working with Cofertility include:
- Power of choice: Freeze your eggs more affordably or, if you qualify, freeze for free when you give half to a family who can’t otherwise conceive.
- Community: Our inclusive online spaces allow you to connect with others going through the process in our private online community.
- Compassion: We’ll always treat you with care, and our Split program gives you the opportunity to make someone’s family building dreams a reality.
- Data-driven: We provide you with trustworthy guidance and evidence-based research so you can make informed decisions about your fertility.
- Free egg freezing: Freeze and store your eggs for 10 years, entirely for free if you qualify for our Split program.
Ready to learn about more affordable (even free!) egg freezing with Cofertility? Fill out this quick quiz to learn about our accessible egg freezing options and see if you qualify for our programs — it only takes one minute.
Whatever your journey looks like, our team is here to guide you through it and keep your family-building options open.
Summing it up
Understanding reproductive health is crucial, especially when it comes to fertility. AMH is a key marker used to assess ovarian reserve, which refers to the quantity eggs. While birth control does not directly impact AMH levels or egg reserve, it can have temporary effects on AMH measurements while being used. The type and duration of birth control can influence the degree of impact on AMH levels.
If you are currently using birth control, it is not necessary to discontinue it before getting an AMH test. However, it's important to be aware that hormonal contraceptives can potentially lower AMH levels temporarily. This means that the AMH results may be lower than they would be if you were not on contraceptives. Consulting with a fertility doctor can provide you with specific guidance on timing and interpretation of AMH results.
If you decide to discontinue birth control, AMH levels should return to their baseline over time as your body adjusts to its natural hormonal patterns. Temporary fluctuations in hormone levels may occur, but these are typically short-lived, and AMH levels should stabilize within a few menstrual cycles. (And if you do discontinue birth control, definitely use backup contraception during that period if you’re trying to avoid pregnancy).
Remember, AMH levels provide valuable insights into ovarian reserve, but they are just one piece of the puzzle when it comes to fertility. Consulting with a fertility doctor can help you understand the broader context of your reproductive health and provide guidance on any concerns or questions you may have.
Read more:
When to Test Your Fertility
When to test your fertility, the importance of early fertility awareness, and proactive measures you can take to understand it.
I was 28 when I first started trying to conceive. I vividly remember taking my last birth control pill, throwing out my pack, and texting my friend to tell her we were no longer “not trying,” excited but nervous. Sounds pretty standard, right? Unfortunately, what I didn’t know at the time was that I was about to embark on a two-and-a-half-year journey to get pregnant with my son. This included several pregnancy losses, a few rounds of IVF, and lots of questions, including, “should I have tested my fertility sooner?”.
I don’t share this to scare anyone. But my story is not all that uncommon. In fact, 1 in 6 individuals experience some form of fertility challenge.
I was woefully unprepared. And because of this lack of preparedness by Sex Ed as well as limited time with my OBGYN, it probably took a good six months before I started to understand what actually goes into conceiving a healthy pregnancy: timing, lifestyle, genetics, and more. So much of my time, stress, and probably money could have been saved by proactive fertility testing.
In this article, we’ll discuss when to test your fertility, the importance of early fertility awareness, and proactive measures you can take to understand it. If you take one thing away from this article, though — the best time to test your fertility is right now. Let’s talk about why.
So what is fertility testing, anyway?
Before we dive into when to test your fertility, it’s important to understand what fertility testing even is.
Ovarian reserve testing
A fundamental concept of assessing one’s fertility is to understand their ovarian reserve. This involves evaluating the quantity of a woman's remaining egg supply (oocytes) in her ovaries. One of the most widely used tests for ovarian reserve (though not without its limitations — more on that below) is the measurement of Anti-Mullerian Hormone (AMH) levels, which can be done with a simple blood test.
Understanding AMH
AMH is a protein produced by cells in the ovarian follicles, with levels of AMH in your blood providing an indication of the number of eggs remaining in your ovaries. If you’re considering egg freezing, AMH testing is especially valuable, as it helps assess your starting point and may indicate a timeline of how urgently you may want to move forward with freezing your eggs.
Your AMH may also give a sense of how your ovaries might respond to the actual egg freezing process. Lower AMH levels typically suggest a diminished ovarian reserve, which may impact fertility potential. In general, an AMH between 1.0 - 3.5 ng/mL is considered a “normal” range.
Individuals with a higher AMH level — which varies by lab, but could be anywhere over 3.0 ng/ml — usually have a better response to ovarian stimulation, leading to a higher number of eggs likely to be retrieved during the procedure. That said, a higher AMH also carries a greater risk of ovarian hyperstimulation syndrome (OHSS), so your doctor will need to be careful with your medication protocol and monitoring.
Should I test my fertility at home or in a clinic?
At-home fertility tests have gained popularity in recent years due to their convenience and privacy. These tests typically involve collecting blood or urine samples and mailing them to a laboratory for analysis. On the other hand, in-clinic fertility tests are conducted at a medical facility, where specialized equipment and healthcare professionals are available.
The pros of at-home fertility tests
- Convenience and privacy: Samples can be collected in the comfort of your home.
- Cost-effective: At-home tests are often more affordable than in-clinic procedures.
- Early assessment: At-home tests allow you to gain insights into your fertility potential before actively trying to conceive. Plus, you won’t have to wait to get squeezed in for an appointment at the clinic!
The pros of testing your fertility at a clinic
- A broader scope: At-home tests may not provide a comprehensive evaluation of fertility health, while testing your fertility at a clinic provides a more comprehensive picture of your fertility. An important note is, when testing your fertility at a clinic, you’ll also undergo a transvaginal ultrasound, where the technician or doctor will be able to get a view of what’s going on in those ovaries and the number of follicles available this cycle.
- Better accuracy: Some at-home tests may have varying levels of accuracy when compared to in-clinic tests.
- Face time: At a clinic, you’ll have the ability to chat directly with a doctor, before and after your results.
When should I test my fertility?
So, when is the “right” age for testing your fertility, anyway?
It depends.
And ultimately, it’s up to you! It’s your body, and your data, and there is no one-size-fits-all answer. We’re firm believers that knowledge is power and you deserve this information. Studies do show that our ovarian reserve declines with age — in other words, it’s a good idea to assess your fertility potential sooner rather than later. That way, if you do want to preventatively freeze your eggs, you can do so while your ovarian reserve is still higher.
According to the American Society for Reproductive Medicine (ASRM), the optimal time to freeze your eggs is in your 20s and early 30s. And this study indicated that, as we get older, our chances increase of needing to do multiple egg freezing cycles in order to achieve a 70% live birth rate. We know we’re a bit of a broken record here, but: the younger you are, the healthier and more plentiful your eggs are.
Consider your egg freezing plans
Because the ASRM doesn’t recommend egg freezing for people older than 38 (although this is not a hard and fast rule), it’s a good idea to test your fertility earlier on if possible. That way, should you decide to move forward with egg freezing, you’ll have the time and space to come up with a plan and hopefully see some successful results.
If and when you decide to move forward with egg freezing, you can freeze your eggs more affordably (even for free!) with Cofertility. Fill out this quick quiz to learn about our accessible egg freezing options and see if you qualify for our programs — it only takes one minute.
Should I test my fertility in my 20s?
Testing your fertility in your 20s gives you the most flexibility. Whether your testing looks great and you want to freeze your eggs now, or you uncover potential fertility risks to address, the more time you have, the better.
Your doctor may even recommend fertility testing if you have past or current reproductive health issues, including sexually transmitted infections (STIs), endometriosis, or PCOS, all of which can contribute to fertility challenges. Even if you’re not yet sure if you want to start a family in the future, testing your fertility in your 20s may help you make informed decisions about family planning options down the line.
Best at-home fertility tests
If you’re curious to learn more about your ovarian reserve, talk to your doctor about fertility testing. If your doctor won’t order the tests…you might want to find a new one who listens to your concerns and takes them seriously. But in the meantime, there are many great at-home fertility testing options out there.
LetsGetChecked Ovarian Reserve Test
Cost: $139
Hormones measured: AMH
Why we like it: While it only tests one hormone, the test is simple and fast. It’s also the least expensive of the three, plus you can get 25% off with code COFERTILITY25.
Natalist Women’s Fertility Test
Cost: $149
Hormones measured: estradiol, LH, FSH, TSH, and total testosterone
Why we like it: Natalist provides comprehensive insights into ovarian reserve, empowering individuals to assess their fertility potential in the comfort of their own homes. Plus, it’s a woman-owned and woman-run company. Use Cofertility20 for 20% off your entire purchase.
Remember: at-home fertility tests aren’t without limitations
Although at-home fertility tests are a great way to get a peek behind the curtain of your fertility, they aren’t without limitations. For starters, according to recent studies, measuring AMH alone may not predict your time to pregnancy. As mentioned above, testing your fertility with a doctor at a clinic will likely provide a more comprehensive picture of your fertility outlook, especially as they consider your medical history, and conduct a physical exam and transvaginal ultrasound. Of course, you’ll also get professional interpretation of the results that you may not receive with an at-home fertility test.
All of that being said, any fertility testing (whether at home or in a clinic) only measures your fertility at that given point in time. It should not be taken as a guarantee for future outcomes. It also can’t tell you anything about your egg quality, which cannot be truly observed until it comes time to actually fertilize those eggs.
Consider egg freezing as a proactive measure
After testing your ovarian reserve, it’s worth considering freezing your eggs if you don’t want kids soon. We’ll be the first to say that egg freezing is not a guarantee for a successful pregnancy in the future — those eggs need to be fertilized into embryos, transferred to a uterus, and then carried for 40 weeks to result in a live birth! But because our fertility declines with age, the earlier we preserve it, the more set up for success we may be in the future if we do need to use those eggs down the line.
How does egg freezing work?
As a primer, egg freezing allows individuals to preserve their fertility by freezing and storing their eggs for future use (fertilization). Let’s get into some of the specifics.
Some benefits of egg freezing
There are many reasons why egg freezing can be beneficial, including:
Delaying parenthood: Egg freezing enables individuals to postpone childbearing to pursue educational, career, or personal goals while increasing their chances of having a healthy pregnancy down the line.
Medical reasons: Some medical treatments, such as chemotherapy or radiation, can impact fertility. Egg freezing offers a proactive option for individuals facing medical conditions that may affect their reproductive health.
Preserve higher quality eggs: As we age, our ovarian reserve diminishes, and the quality of our eggs declines. By freezing eggs at a younger age, individuals can preserve their eggs when they are of higher quality.
The egg freezing process
Overall, the egg freezing process is a 10-14 day period involving ovarian stimulation, the actual egg retrieval, and storing the frozen eggs. Here’s what goes into each.
Ovarian stimulation: Before the egg retrieval, individuals typically take injectable hormone medications for about 10-14 days. This process encourages the ovaries to produce multiple mature eggs. You’ll head to the clinic for monitoring every few days (more frequently as you get closer to your retrieval) so your doctor can check on how things are progressing and make updates to your medication protocol if needed.
The egg retrieval: Once the eggs are mature, a minimally invasive procedure known as transvaginal ultrasound-guided aspiration is performed to retrieve the eggs from the ovaries. The procedure is usually well-tolerated and does not require a surgical incision.
Cryopreservation: After retrieval, the eggs are frozen using a process called vitrification. This method prevents the formation of ice crystals, which could damage the eggs during freezing. You’ll store your eggs in a special storage facility meant for just that.
For an in-depth overview of the egg freezing process, click here.
Success rates of egg freezing
The success of egg freezing largely depends on the age at which the eggs are frozen. Generally, eggs frozen at a younger age have a higher chance of resulting in a successful pregnancy. Advanced vitrification techniques have significantly improved egg freezing success rates, with some studies reporting comparable pregnancy rates between fresh and frozen-thawed eggs.
One study of 1,241 women found that the average number of eggs retrieved on the first egg freezing round was:
- 21 eggs for women under 35
- 17 eggs for women 35-37
- 14 eggs for women 38-40
But, in addition to egg quantity, we also need to consider egg thaw survival rate, and the rate at which these eggs become embryos and result in a live birth. According to a study in the Journal of Assisted Reproduction and Genetics, a woman under 35 will need 9 eggs to achieve a 70% chance of having at least one live birth. If you’re trying to conceive in your mid to late 30s, you may need double as many eggs to achieve that same 70% success rate.
Not only will freezing your eggs proactively give you the options of utilizing higher quality eggs in the future, it also helps alleviate the pressure of finding a reproductive partner, and can allow us to feel empowered to make family planning decisions on our own terms without any compromises. Taking a proactive approach to fertility preservation can provide the freedom to pursue opportunities without sacrificing the dream of having a family when the time is right.
Freezing your eggs with Cofertility
With Freeze by Co, you have the opportunity to apply to our Split program, where you can freeze your eggs for free when you donate half of the retrieved eggs to a family that can’t otherwise conceive. The cost of the entire process, including 10 years of cryopreservation, is fully covered.
Or, if you want to freeze and store your eggs for your own future use without donating, as part of our Keep program, we offer lower prices on things like consultations and storage, along with access to our community of others going through the process at the same time. Plus, you’ll have direct access to our team, which is here to support you throughout the entire journey.
Summing it up
If you’re considering testing your fertility, the best age to do it is now. Whether you test yourself at home, or with a doctor at a fertility clinic, testing your fertility can provide valuable insights into what your family-building future may look like. It might also uncover the need for egg freezing in order to preserve some of your existing fertility as it stands today. But whatever you decide to do with the results, you’ll at least be armed with more information about yourself than you would have had otherwise.
Female Fertility Hormones: Everything They Didn’t Teach You in Sex Ed
We've got all the details on those tiny chemical messengers that hold the key to your reproductive prowess. Whether you're curious about boosting your chances of egg freezing success or simply want to understand the inner workings of your amazing body, this article will dive into a hormonal adventure that will leave you feeling empowered and in control. Let’s go!
Are you ready to embark on a journey through the fascinating world of female fertility hormones? We've got all the details on those tiny chemical messengers that hold the key to your reproductive prowess. Whether you're curious about boosting your chances of egg freezing success or simply want to understand the inner workings of your amazing body, this article will dive into a hormonal adventure that will leave you feeling empowered and in control. Let’s go!
Anti-Mullerian Hormone (AMH)
What it is
The most talked about hormone of them all: AMH. AMH is produced by the developing follicles in the ovaries and serves as an biomarker of ovarian reserve. It helps estimate the quantity of eggs remaining in the ovaries and is commonly used in assessing how well your body will respond to IVF or egg freezing.
Normal AMH levels
You can take an AMH test any time in your cycle. In general, AMH levels can be interpreted by:
- Above 1.0 ng/ml (nanograms per deciliter): Normal
- Below 1.0 ng/ml: Showing weakness in the ovarian reserve
- Below 0.5 ng/ml: Showing severe weakness in the ovarian reserve
Keep in mind that lab numbers can vary. Your blood test results will show the lab’s normal range on the report.
What AMH can tell you
As we age, our AMH levels naturally decrease until we hit menopause and our AMH reaches 0. While the decline in fertility happens to ALL of us, the specific age when we can no longer conceive varies from individual to individual. And in some cases, it may be earlier than expected. AMH can give us insight into where we are on that journey.
While AMH is pretty awesome, there are two things it can’t tell us: (1) it can’t tell us the quality of the eggs remaining and (2) it can’t tell us our chances of getting pregnant unassisted.
Estrogen
What it is
Estrogen hormone is the ultimate multitasker, responsible for so many amazing things. It's the power behind that glowing, radiant skin and full, thick hair. And it also takes charge of thickening the uterine lining each month, which either sets the stage for a growing embryo, or culminates in your period.
Estrogen is actually a collective term used to describe a group of hormones that play a vital role in the female reproductive system. It includes three types of hormones:
- Estrone (E1) which is the only type of estrogen that our bodies keeps making even after menopause
- Estradiol (E2) causes the maturation and release of the egg as well as the thickening of the uterus lining each month
- Estriol (E3) is really only present during pregnancy, and helps the uterus grow and stay healthy
Estrogen levels fluctuate throughout the menstrual cycle, with estradiol being the dominant form during the follicular phase (leading up to ovulation) and progesterone taking the lead during the luteal phase (after ovulation). Understanding the dynamics and functions of estrogen and estradiol can help shed light on the intricate mechanisms underlying female reproductive health.
Altogether, estrogen plays a key role in regulating the menstrual cycle, supporting the growth and development of the uterus and breasts, and maintaining bone health.
Normal E2 levels
Estrogen levels fluctuate throughout your life, often aligning with other hormones that regulate crucial bodily functions, such as the menstrual cycle. These dynamic changes in estrogen levels are considered a normal part of the body's hormonal rhythm.
Estradiol (E2) is the hormone most often tested for fertility. E2 levels vary widely through the menstrual cycle, and are expected to fluctuate from test to test. A normal range is considered:
- Premenopausal: 30 to 400 pg/mL (110 to 1468.4 pmol/L)
- Postmenopausal: 0 to 30 pg/mL (0 to 110 pmol/L)
There can be variations in the normal value ranges for laboratory tests, as different laboratories may use different measurement methods (e.g. saliva, blood prick, or venipuncture) or test different samples. Your doctor will be able to provide you with accurate interpretation and insights based on your individual circumstances.
What E2 can tell you
If you consistently test on the lower range, it may indicate the onset of menopause, premature ovarian failure, or low estrogen from rapid weight loss or anorexia. If your results are higher, it may suggest a tumor of the ovary.
Follicle-Stimulating Hormone (FSH)
What it is
FSH is the ultimate fertility cheerleader. Like the squad captain, FSH leads the charge in the growth and development of those ovarian follicles, which contain the eggs. It's the one shouting, "Let's grow those eggs, ladies!"
Our FSH levels change throughout the menstrual cycle, with the highest levels happening just before ovulation (when an egg is released by the ovary).
Normal FSH levels
For fertility testing, you need to have the FSH blood test on day 3 of your menstrual cycle (day 1 is the day your period begins). In general, normal FSH levels are:
- Premenopausal: 4.7 to 21.5 mIU/mL
- Postmenopausal: 25.8 to 134.8 mIU/mL
Keep in mind that lab numbers can vary. Your blood test results will show the lab’s normal range on the report.
What FSH can tell you
Higher-than-normal levels of FSH can be a sign of infertility due to premature ovarian failure or menopause. It could also be due to certain types of tumors in the pituitary gland, or due to Turner syndrome.
Lower levels could mean pregnancy, being very underweight or having had recent rapid weight loss, not ovulating, or that parts of the brain are not producing normal amounts of hormones. If you have abnormal results, your doctor will discuss your situation and next steps.
Luteinizing Hormone (LH)
What it is
This hormone takes center stage and demands attention as it triggers the grand finale of the menstrual cycle: the release of a mature egg. LH sends that egg on its way, ready for its moment in the spotlight and a chance at fertilization.
While LH has a major job for our reproductive system, it’s actually secreted by a tiny structure in your brain called the pituitary gland.
Normal LH levels
LH fluctuates throughout your cycle, and the ranges are:
Premenopause: 5 to 25 IU/L
Postmenopause: 14.2 to 52.3 IU/L
Remember, lab numbers can vary. Your blood test results will show the lab’s normal range on the report.
What LH can tell you
Abnormal LH levels can indicate ovulatory disorders, such as polycystic ovary syndrome (PCOS) or hypothalamic amenorrhea.
LH testing (via urine test strips) can also help to predict ovulation. By detecting the LH surge each cycle, these test strips give us a glimpse into our fertile windows, or when we’re most likely to get pregnant.
Progesterone
What it is
Progesterone swoops in after ovulation (which, remember, was ushered in by LH) to prepare the uterine lining, transforming it into a cozy, welcoming haven for a potential embryo. Progesterone is crucial for early pregnancy, helping maintain the thickened endometrium. But if an egg isn’t fertilized during that cycle, progesterone levels decrease, your uterine lining thins, and your period begins.
Normal progesterone levels
- Pre-ovulation: less than 1 nanogram per milliliter (ng/mL) or 3.18 nanomoles per liter (nmol/L)
- Mid-cycle: 5 to 20 ng/mL or 15.90 to 63.60 nmol/L
- Postmenopausal: less than 1 ng/mL or 3.18 nmol/L
- Pregnancy 1st trimester: 11.2 to 90.0 ng/mL or 35.62 to 286.20 nmol/L
- Pregnancy 2nd trimester: 25.6 to 89.4 ng/mL or 81.41 to 284.29 nmol/L
- Pregnancy 3rd trimester: 48 to 150 to 300 or more ng/mL or 152.64 to 477 to 954 or more nmol/L
What progesterone can tell you
While LH tests can help us predict when we’re about to ovulate, progesterone tests can help confirm if we actually did ovulate.
If you have low progesterone and aren’t pregnant, you may have symptoms like irregular periods, infertility, mood changes, trouble sleeping, or hot flashes.
If you have low progesterone and are pregnant, it could mean a higher risk of miscarriage or an ectopic pregnancy.
Prolactin
What it is
Prolactin is the hormone that orchestrates the magic of breastfeeding. It causes the breasts to grow and make milk during pregnancy and after birth. While its primary role lies in the breastfeeding realm, elevated levels of prolactin when not pregnant or postpartum can sometimes interfere with ovulation and menstrual regularity.
Normal prolactin levels
Made in the the pituitary gland, normal levels of prolactin are:
- Nonpregnant: less than 25 ng/mL (25 µg/L)
- Pregnant: 80 to 400 ng/mL (80 to 400 µg/L)
Keep in mind that lab numbers can vary. Your blood test results will show the lab’s normal range on the report. Talk to your doctor about your specific results.
What prolactin can tell you
Abnormally high levels of prolactin when you are not pregnant could mean a condition called hyperprolactinemia, which is actually quite common. Believe it or not, about a third of women in their childbearing years with irregular periods (but perfectly normal ovaries) have hyperprolactinemia. Hyperprolactinemia could mean trouble getting pregnant. Not to mention, your boobs might start producing milk when you're not even expecting it (hello, galactorrhea!).
High prolactin levels can also throw a wrench in the normal hormone production, messing with the likes of estrogen and progesterone. And when that happens, it can disrupt ovulation or lead to irregular or missed periods.
Thyroid-Stimulating Hormone (TSH)
What it is
This hormone ensures that our thyroid gland, that tiny powerhouse in our neck, is working harmoniously. Thyroid health is crucial for maintaining menstrual regularity and fertility, so when TSH steps onto the scene, you know it's time to keep that thyroid in check!
Normal TSH levels
Another hormone produced by the pituitary gland, TSH can give us insight into thyroid disorders, such as hypothyroidism or hyperthyroidism.
- Nonpregnant: 0.27 – 4.2 uIU/mL.
- First trimester (9 to 12 weeks): 0.18 – 2.99 (uIU/mL).
- Second trimester: 0.11 – 3.98 uIU/mL.
- Third trimester: 0.48 – 4.71 uIU/mL.
What TSH can tell you
Low levels of TSH typically indicate hyperthyroidism, or overactive thyroid, when your thyroid gland is making excess thyroid hormone. On the other hand, high levels of TSH may suggest an inadequate production of thyroid hormone, leading to a condition called hypothyroidism or underactive thyroid.
Testosterone
While testosterone is often associated with male reproductive health, females also produce small amounts of testosterone from the ovaries. It helps preserve muscle mass and supports an overall sense of wellbeing. It also helps the development of those follicles and even plays a role in boosting our libido.
Testosterone does fluctuate throughout your cycle, so if you notice that your libido surges at certain times of your cycle (usually around ovulation), you can thank testosterone.
Normal testosterone levels
15 to 70 ng/dL or 0.5 to 2.4 nmol/L
What testosterone can tell you
Abnormal testosterone levels can negatively affect fertility.
Too little testosterone could mean you are nearing menopause or have premature ovarian failure. It could also be lower due to certain medications, malnutrition, chemotherapy/radiation,
Too much testosterone could be a sign of PCOS.
At-home fertility hormone testing
If you’re curious to test your hormones, you'll be glad to know that there are convenient at-home options available. These tests allow you to assess your hormone levels from the comfort of your own home, providing valuable insights into your reproductive health.
Let's take a closer look at some of the top at-home fertility hormone testing options for you to consider:
- Natalist Women’s Fertility Test: Priced at $149, this comprehensive test covers a range of essential hormones. It measures five key hormones: estradiol, LH, FSH, TSH, and total testosterone. By examining these hormone levels, you can gain a better understanding of your reproductive health. And here's a bonus for our readers: use the code COFERTILITY25 to get 25% off!
- LetsGetChecked Ovarian Reserve Test: For $139, this test specifically focuses on measuring anti-Müllerian hormone (AMH), a critical marker for ovarian reserve. By understanding your ovarian reserve, you can make informed decisions about family planning and fertility preservation. And guess what? You can save 25% on this test by using code COFERTILITY25.
These at-home fertility hormone testing options give you the opportunity to better understand your reproductive health. But keep in mind that if you are planning to freeze your eggs, your doctor may want you to test again.
Summing it up
These fertility hormones - AMH, Estrogen, FSH, LH, Progesterone, Prolactin, and Testosterone– work in harmony to regulate the menstrual cycle, facilitate ovulation, prepare the uterus for pregnancy, and support early gestation.
Imbalances or abnormalities in these hormone levels can affect fertility and reproductive health. Unfortunately for many of us, we don’t find out there’s a problem until we start trying.
Evaluating the levels of these hormones through diagnostic tests can provide insights into your fertility health and empower you with knowledge to make informed decisions about your reproductive journey.
By understanding your hormone levels, you can identify potential issues that may hinder reproductive health, now or in the future.
Sources:
- Estradiol (Blood). Health Encyclopedia. University of Rochester Medical Center. URL
- Follicle-stimulating hormone (FSH) blood test. Mount Sinai. URL
- Shufelt CL, Torbati T, Dutra E. Hypothalamic Amenorrhea and the Long-Term Health Consequences. Semin Reprod Med. 2017;35(3):256-262. doi:10.1055/s-0037-1603581. URL
- Hyperprolactinemia (High Prolactin Levels). ReproductiveFacts.org. URL
- Testosterone. Mount Sinai. URL
- Soman M, Huang LC, Cai WH, et al. Serum androgen profiles in women with premature ovarian insufficiency: a systematic review and meta-analysis. Menopause. 2019;26(1):78-93. doi:10.1097/GME.0000000000001161. URL
How to Support Your Partner Through the Cofertility Split Program
If you are part of Cofertility’s Split Program, or even donating your eggs elsewhere, this is a helpful guide to share with your partner.
If you are part of Cofertility’s Split Program, or even donating your eggs elsewhere, this is a helpful guide to share with your partner.
At Cofertility, we are on a mission to support individuals and families across different phases of the fertility journey. Our work transcends the boundaries of traditional fertility care, forging connections that breathe life into the dreams of thousands of families, both today and the future.
Through our unique Split Program, we've had the privilege of working with many egg freezers and donors, and know the experience varies widely. We've witnessed joy, apprehension, hope, and triumph, and we've come to recognize that the process of egg sharing is multifaceted and profound. Our journey with these remarkable individuals has not only exposed us to the wide spectrum of emotions and decisions, but has also underscored the indispensable role of a robust support system throughout the journey.
Becoming an egg donor presents a multitude of emotional, physical, and ethical considerations. How, then, can friends, family, or significant others support a Split member during this journey?
In the following guide, we hope to share the insights we've gathered, offering a pathway for those seeking to support a loved one through this journey.
Understand the process
It’s helpful for you to understand the logistical and medical process your partner or loved one is going through. Here are a few guides to get up to speed:
- What's the Egg Retrieval Process Like?
- Everything You Need To Know About Egg Freezing Medication
- The Ultimate Guide to the Split Program
- Disclosed vs. Undisclosed Egg Donation: How Should I Choose?
- What are the Side Effects and Risks of Egg Freezing?
Offer assistance
The Split members' journey with egg freezing will require numerous medical appointments for ultrasounds and bloodwork. Your presence at these appointments can provide a reassuring sense of companionship.
But the most important task is being their reliable ride home from the egg retrieval procedure (in fact, it’s required that they do not drive after this procedure). This might be a clinic near home or you may be asked to travel with your partner to a clinic near the intended parents (if this is the case, travel expenses for both of you will be covered).
Once they get home, ensuring they have the things they need to be comfortable—whether it's a favorite blanket, soothing tea, or just your comforting presence—can make a significant difference in their experience. These thoughtful actions underscore the human connection at the heart of this medical process, turning what could be a solitary journey into a shared experience of empathy and care.
Egg freezing is considered a safe procedure, and complications are rare. But you should know the red flags. If you notice any of the symptoms below, report them to the healthcare provider asap:
- Temperature above 101 F
- Severe abdominal pain or swelling
- Severe nausea or vomiting that doesn’t go away
- Heavy vaginal bleeding (soaking through a pad in an hour; some light bleeding is normal)
- Difficulty urinating, or painful urination
- Fainting or dizziness
Help with the shots
The first step in the egg freezing process is to stimulate the ovaries to produce multiple eggs to be retrieved. This is done with the use of fertility medication, administered in the form of injectable hormones over 10-12 days.
Helping your loved one with these required injections is huge. This is not a task for everyone, and it's completely understandable if it falls outside your comfort zone. If you do have the capacity and willingness to assist with administering the shots, your help would undoubtedly be appreciated.
However, even if you prefer not to take a hands-on role, your presence while they give themselves the shot can still make a meaningful difference.
Simply keeping them company, offering words of encouragement, or offering a little treat (chocolate?) or surprise after each shot can transform an intimidating necessity into a shared moment of support and connection.
Respect the decision
Friends, family, and partners should respect the donor's autonomy in this deeply personal decision. Recognize that this choice belongs solely to the person making it, and it may reflect a multitude of considerations, both practical and emotional.
Respecting this decision requires acknowledging your partner's autonomy and avoiding any attempts to influence or question her choice. Supporting her means listening without judgment, asking thoughtful questions to understand her perspective, and reassuring her of your support.
Research shows that egg donors are generally happy with their decision and the vast majority do not regret it (in one study of an egg sharing program, only 2.1% regretted their decision to participate). And anecdotally speaking, donors we work with at Cofertility are grateful for the opportunity to donate their eggs and keep half of the eggs retrieved for their own future use, for free.
Concerns and curiosity are natural, but they must be handled with delicacy and empathy. Being there for her doesn't mean agreeing with her on every point but rather offering a safe space where she can express her feelings and thoughts freely.
Empirical studies on autonomy and healthcare decisions reinforce the importance of respecting individual choices, particularly those concerning one's body and reproductive rights. In the context of egg donation, this principle becomes paramount, reflecting the ethical, emotional, and personal dimensions of the choice at hand.
Celebrate the achievement
Egg freezing and donation can be an expression of personal values, a decision that encapsulates a woman's beliefs, or simply an achievement that deserves acknowledgment and celebration.
Celebrating this achievement can take many forms, from simple words of congratulations and admiration to more elaborate expressions of support. It might mean throwing a small celebration, writing a heartfelt letter, or finding another personal way to convey pride and gratitude.
Celebration does not necessarily mean a public declaration but rather an authentic and personal acknowledgment of the strength, courage, and compassion embodied in the decision itself. The act of recognizing and honoring this choice can create a shared moment of joy and connection, strengthening the bonds between the donor and those closest to her.
In summary
Through our work with hundreds of donors, we've learned that the path is never solitary, nor should it be. The role of friends, family, partners, and significant others in this process cannot be overstated.
From understanding the technical aspects of the process to being a comforting presence during medical appointments, offering assistance with injections, respecting personal choices, and celebrating the decision, the support system surrounding a donor becomes an integral part of the experience. These connections not only ease the logistical and emotional challenges but transform the process into a shared journey that's imbued with empathy, respect, and love.
Our commitment to supporting individuals and families remains unwavering. By fostering a robust network of support and sharing our insights, we hope to make the journey not only more approachable but also more meaningful. The dreams of creating and nurturing life are collective ones, and we at Cofertility are honored to be part of these intimate and extraordinary stories.